BACKGROUND: Cardiopulmonary bypass during open heart surgery causes systemic inflammatory respose. IL-10 is an anti-inflammatory cytokine that inhibits inflammatory process and protects organ function by down regulation of pro-inflammatory cytokine release and maintenance of blood level balance with pro-inflammatory cytokines. MATERIAL ateial and Method: Plasma IL-10 levels were measured and analyzed in 22 patients who underwent open heart surgery (11 cases of coronary artery bypass graft, 11 cases of valve replacement) under cardiopulmonary bypass since 1988 January to July at Department of Thoracic and Czardiovascular surgery, Yeungnam University Hospital. 1g of methylprednisolone was administrated to thirteen patients randomly. Blood samp.es were taken and collected at the time of induction of anesthesia, 10 min before cardiopulmonary bypass, 10 min after starting of CPB, 10 min aftr aortic cross clamping, 10 min after ACC release, and 10 min, 2 hours, and 5 hours after CPB respectively. The plasma levels of IL-10 were determined by enzyme-linked immunosorbent assays (ELISA). Wilcoxon-Raule Sum test was used for statistical analysis. In all 22 patients, cardiopulmonary bypass time was used for statistical analysis. In all 22 patients, cardiopulmonary bypass time was 171+/-41.4 min and aortic cross clamp time was 118+/-36.5 min. Peak IL-10 level was achieved at 10 min after ACC (361.0+/-52.81pg/ml) and was decreased sharply at 2 hours after CPB. Peak IL-10 level was correlated positively with aortic cross clamp time (p=0.011); however, it did not correlated with bypass time (p=0.181). In valve replacement group, mean IL-10 level at peak point was 567.89+/-107.69 pg/ml and was significantly higher than that of coronary artery bypass group (205.67+/-192.70 pg/ml) (p<0.001). ACC time in valve replacement group was significantly longer than that of coronary artery bypass group (p<0.01), however, bypass time was not (p=0.212). Thirteen patients with steroid pretreatment before starting of CPB showed relatively higher plasma IL-10 level than in control group, however, no statistical significance was noted (p=0.19). CONCLUSION: plasma level of IL-10 was increased in association with cardiopulmonary bypass and revealed peak at 10 min after ACC release. IL-10 level was correlated positively with ACC time. Therefore, systemic inflammatory respeonse in association with cardiopulmonary bypass could be decreased by reducing ACC time during cardiac surgery.
Anesthesia ; Cardiopulmonary Bypass* ; Constriction ; Coronary Artery Bypass ; Cytokines ; Down-Regulation ; Enzyme-Linked Immunosorbent Assay ; Humans ; Interleukin-10* ; Methylprednisolone ; Plasma ; Thoracic Surgery ; Transplants

Congenital bronchobiliary fistual is a rare disease with unclear etiology. An abnormal tract communicates the tracheobronchial junction to a hepatic segment, usually the left lobe. Billous sputum, a positive HIDA(o-Dimethyliminodiacetic acid) scan, and a trification at the level of the carina lead to the diagnosis, which can be confirmed by bronchoscopic contrast injection. We experienced a case of congenital bronchobiliary fistual in a 27-day-old girl. Our case is reported with literature reviews.
Diagnosis ; Female ; Fistula* ; Humans ; Rare Diseases ; Sputum

BACKGROUND: This study was performed to evaluate the incidences, the risk factors, and the clinical course of the hyperamylasemia in patients who underwent open heart surgery under cardiopulmonary bypass. MATERIAL AND METHOD: Thirty seven patients who underwent cardiopulmonary bypass were studied at Department of Thoracic & Cardiovascular Surgery, Yeungnam University Hospital, from July 1997 to June 1998. The thirty seven patients were divided into two groups, 13 patients in group I had normal serum amylase levels and 24 patients in group II had hyperamylasemia. Mean serum amylase(IU/l) levels and 24 patients in group II had hyperamylasemia. Mean serum amylase(IU/l) levels of gorup II showed 54.3+/-4.6, 78.0+/-9.2, 372.0+/-103.4, 460.5+/-80.4, 280.4+/-46.6, and 131.0+/-15.6, preoperative, immediate postoperative, at postoperative 1, 2, 3, and 7 days, respectively. In group II, serum amylase level of the postoperative day 2 was the highest and was significantly higher than that of the preoperative day (p<0.001). Serum amylase level started to decreased at postoperative day 3 and returned to the normal level at postoperative day 7. Significant clinical symtoms of overt pancreatitis were not shown in patients in group II. The following perioperative variable such as diagnosis, cardiopulmonary bypass time, aortic cross clamping time, mean systemic pressure during bypass, and administration of steroid were compared between groups. There were no significant differences between groups. In all patients, Serum amylase level of postoperative day 2 and aortic cross clamping time were correlated significantly (p=0.047). CONCLUSION: Serum amylase level after cardiopulmonary bypass could be elevated postoperatively and serum amylase level of POD 2 was considered to have significant correlation with aortic cross clamping time. Shortening of aortic cross clamping time will help in reducing the hyperamylsemia. In this study, although significant clinical symptoms and overt pancreatitis were not seen from hyperamylsemic patients, careful clinical observation of hyperamylasemia would be necessary.
Amylases ; Cardiopulmonary Bypass* ; Constriction ; Diagnosis ; Humans ; Hyperamylasemia* ; Incidence ; Pancreatitis ; Risk Factors ; Thoracic Surgery

The long QT syndromes have been classified into acquired or inheritary forms, both of which are associated with a characteristic type of life-threatening polymorphic ventricular tachycardia called torsade de points. Beta-adrenergic blocker is the first cholic treatment, but in those whom cardiac events are not prevented by beta - blockade, left thoracic sympathetic ganglionectomy may be useful in selected cases. A 50-year-old woman had an recurrent syncopal attack in which she was unconscious for 1-2 min and 1-2 times a month for 10 years. The EKG revealed that QT & QTc intervals were 744 and 632 msec respectively. Treatment with Beta-adrenergic blocker and calcium channel blocker was ineffective in preventing recurrence of syncopal spell. Therefore, she underwent left thoracic sympathetic ganglionectomy with thoracoscope. During the 9 months after operation, she was free of syncopal episodes and is doing well.
Calcium Channels ; Electrocardiography ; Female ; Ganglionectomy* ; Humans ; Long QT Syndrome* ; Middle Aged ; Recurrence ; Syncope ; Tachycardia, Ventricular ; Thoracoscopes*

Isolated congenital aneurysm of the left atrium with intact pericardium is a rate anomaly, which usually presents with arrhythmia, cerebral embolism or abnormalities on routine chest X-ray. Surgery is indicated in most cases to eliminate a potential source of systemic emboli and arrhythmias. A 42-year-old woman having cervical cancer, she was suspected of having a left atrial aneurysm on review of chest X-ray and confirmed by echocardiography and cardiac catheterization. Surgical resection of Left atrial aneurysm was achieved without complication using median sternotomy with cardiopulmonary bypass. The postoperative course was uneventful.
Adult ; Aneurysm* ; Arrhythmias, Cardiac ; Cardiac Catheterization ; Cardiac Catheters ; Cardiopulmonary Bypass ; Echocardiography ; Female ; Heart Atria* ; Humans ; Intracranial Embolism ; Pericardium ; Sternotomy ; Thorax ; Uterine Cervical Neoplasms

BACKGROUND: Recent trends suggest that minimally invasive cardiac surgery reduces postoperative morbidity and offers a cosmetic benefit. This study was performed to evaluate the CPB time, ACC time, OP time, ICU stay and postoperative hospital stay following a lower partial sternotomy and those of the median sternotomy. MATERIAL AND METHOD: A group of 26 adult patients who underwent cardiac surgery through lower partial sternotomy from August 1997 to July 1999 (A group) were compared to 45 adult patients who underwent cardiac surgery through median sternotomy from January 1996 to July 1997 (B group). The mean ages (46.4+/-14.6 years, A group and 46.8+/-13.2 years, B group) were similar. Operations were performed with central cannula and antegrade/retrograde blood cardioplegia. RESULT: There was no death in each group. No differences were found in CPB time, ACC time, OP time, ICU stay and postoperative hospital stay. Postoperative complications were sternal splitting in a patient in group A and a patient with bleeding that required reoperation and a patient with delayed wound closure in group B. CONCLUSION: The lower partial sternotomy offered a cosmetic benefit, but does not significantly reduced the length of operative time and hospital stay. Minimally invasive cardiac surgery will be applied increasing because of the suggested advantage and choosing a proper operative technique will be helpful.
Adult ; Catheters ; Heart Arrest, Induced ; Hemorrhage ; Humans ; Length of Stay ; Operative Time ; Postoperative Complications ; Reoperation ; Sternotomy* ; Thoracic Surgery* ; Wounds and Injuries

19 cases of non-pineal intracranial germ cell tumors were reviewed retrospectively with both radiologic andclinical featurses. The results were as follows: 1. The age distribution was 8 to 32 year old (16 year old of meanage) and the sex distribution shows male predominence(15:4). 2. The histopathologic diagnosis included 11 cases ofgeminoma, 2 cases of mixed germ cell tumor, 1 case of embryonal cell carcinoma and 5 cases of unknown. 3. Thelocation of tumors was the suprasellar region in 8 cases, the left basal ganglia and thalamus in 5 cases, and theright frontal lobe in 1 case. Among 11 cases of geminoma, 6 cases involve the suprasellar region and 3 cases theleft basal ganglia and thalamus. 4. In clinical features, there were visual disturbance, diabetes insipidus,increased ICP signs, motor weakness, hormonal disorders, and personal changes in order. 5. In tumor marker studyof 6 cases of geminoma, 5 cases show increase in HCG, titie, but all 6 cases were normal in AFP titer. 6. In brainCT, most of all revealed well-defined homogeneous high density with or without small central low density andhomogenous enhancement at solid portion,and there was calcification in only case with mixed germ cell tumor.
Age Distribution ; Basal Ganglia ; Brain ; Diagnosis ; Frontal Lobe ; Germ Cells ; Humans ; Male ; Neoplasms, Germ Cell and Embryonal ; Retrospective Studies ; Sex Distribution ; Thalamus

No abstract available.
Glomerular Basement Membrane*

PURPOSE: The effects of 5HT3 receptor agonist and antagonist on rabbit intraocular pressure (IOP) and pupil size were evaluated. METHODS: A 5HT3 receptor agonist, I-Phenylbiguanide (PBG, 1%) and a 5HT3 receptor antagonist, 3-Tropanyl-indole-carboxylate methiodide (ICS-205,930) were applied topically to the rabbit eye, and intraocular pressure and pupil diameter were checked with a Tono-PenTM XL and a ruler. RESULTS: Topical application of 1% PBG significantly increased IOP by 4.6+/-1.2 mmHg (p<0.001) over a period of up to 2 hours, the IOP maximum reached at 1 hour and caused pupil dilatation by 3.3+/-0.3mm (p<0.001) over a period of up to 5 hours, the dilation maximum reached at 2 hour. Topical preadministration of 1% ICS-205,930 prevented a rise in IOP but did not counteract on the pupil dilatation brought about by 5HT3 receptor agonist. CONCLUSIONS: These findings indicate that topically applied 5HT3 receptor agonist could raise IOP and dilate pupil.
Dilatation ; Intraocular Pressure* ; Pupil* ; Rabbits*

PURPOSE: To evaluate the effect of autologous blood injections for late-onset filtering bleb leakage after trabeculectomy METHODS: Retrospective chart review was done on 15 patients 16 eyes that had autologous blood injection(s) for filtering bleb leak occurring later than 2 months after trabeculectomy at the Masan Samsung Hospital. Successful treatment was defined as resolution of the bleb leak and no need for additional glaucoma medications. Failure was defined as a persistent bleb leak, intraocular pressure greater than 21 mm Hg, or the occurrence of a vision-threatening event related to the procedure. RESULTS: The mean age of the patients was 53.9 years old (38~74 years). Ten eyes were men (62.5%) and 6 were women (37.5%). Sixteen eyes of 15 patients had autologous blood injection for filtering bleb leak and were followed for a mean of 12.7 months (SD, 5.8; range, 3 to 25 months). Eleven eyes (68.7%) were classified as failures because of persistence of the leak. Five eyes (31.3%) had an initially successful outcome, but the success rate decreased over time as bleb leaks recurred in one of the five eyes at 3 month. Mean intraocular pressure increased from 4.9mmHg at pretreatment to 7.6 mmHg at final examination (P<0.05). Snellen visual acuity (with correction or pinhole) remained within 2 lines of pretreatment acuity in 12 eyes (75%). Blood seepage into the anterior chamber after autologous blood injection was the common complication, but it was transient. CONCLUSIONS: Although it showed limited success, autologous blood injection for late-onset bleb leak may be considered as a supportive measure before preforming invasive incisional surgery.
Anterior Chamber ; Blister* ; Female ; Glaucoma ; Humans ; Intraocular Pressure ; Male ; Retrospective Studies ; Trabeculectomy* ; Visual Acuity